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Diabetes in pregnancy

Diabetes that develops during pregnancy is known as gestational diabetes. It may occur because your body cannot produce enough insulin (a hormone important in controlling blood glucose) to meet its extra needs in pregnancy.

Without treatment gestational diabetics results in high blood glucose levels. Gestational diabetes usually starts in the middle or towards the end of pregnancy.

How common is gestational diabetes?Show [+]Hide [-]

Gestational diabetes is very common, affecting 18 in every 100 pregnant women.

You are more likely to develop gestational diabetes if:

your body mass index (BMI) is 30 or more

you have previously given birth to a large baby, weighing 4.5 kg (10 lbs) or more

you have had gestational diabetes before

you have a parent, brother or sister with diabetes

you have had a stillborn baby or a baby who died in the first four weeks after birth

your family origin is South Asian, Chinese, African-Caribbean or Middle Eastern

How will I be checked for gestational diabetes?Show [+]Hide [-]

If you have any of the above risk factors, we offer a glucose tolerance test (GTT) between 24 and 28 weeks of pregnancy.

A GTT involves fasting overnight (not eating or drinking anything apart from water). In the morning, before breakfast, you will have a blood test. You are then given a glucose drink. The blood test is repeated 1–2 hours later to see how you body reacted to the glucose drink.

If you have had gestational diabetes in a previous pregnancy, you are offered a glucose test at around 16 weeks as well as a GTT at 24 to 28 weeks in pregnancy.

What does gestational diabetes mean for me and my baby?Show [+]Hide [-]

Most women have a healthy pregnancy and healthy baby but occasionally gestational diabetes can cause serious problems. Diagnosing and treating gestational diabetes reduces these risks.

It is important to carefully control the amount of glucose in your blood. Too much glucose allows your baby to overfeed on this sugar and grow heavier than usual. This increases the risk of:

recommending your labour is induced

caesarean section

serious birth problems and stillbirth.

To compensate for the extra glucose your baby makes extra insulin. After birth your baby has too much insulin in the blood stream which can lower the blood glucose levels too far. This can be serious for your baby and may need additional treatment in the neonatal unit.

Your baby may also be at greater risk of developing obesity and/or diabetes in later life.

Controlling your blood glucose levels during pregnancy and labour reduces the risks of all these complications for you and your baby.

What extra care will I need during pregnancy?Show [+]Hide [-]

You will be under the care of a specialist healthcare team, a specialist diabetes midwife, an obstetrician, a doctor specialising in diabetes, a specialist diabetes nurse, and a dietician. Having gestational diabetes will mean more RVI clinic visits for this specialized care.

The most important treatment for gestational diabetes is a healthy eating plan and exercise.

Gestational diabetes usually improves with these changes although some women despite their best efforts, need to take tablets or give themselves insulin injections.

After you have been diagnosed with gestational diabetes, you will be shown how to check your blood glucose levels and told what your ideal level should be. If it does not reach a satisfactory level after one or two weeks, or if an ultrasound scan shows that your baby is larger than expected, you may need to take tablets or give yourself insulin injections.

You will be offered extra ultrasound scans to monitor your baby’s growth more closely.

Will I need treatment?

Two in every 10 women with gestational diabetes will need to take tablets or insulin injections to control their blood glucose during pregnancy. If you do need insulin, your specialist diabetes nurse will explain exactly what you need to do. This will include showing you how to inject yourself with insulin, how often to do it and when you should check your blood glucose levels.

When is the best time for my baby to be born?Show [+]Hide [-]

Ideally you should have your baby between at 38 and 40 weeks of pregnancy, depending on your individual circumstances.

What happens after my baby is born?Show [+]Hide [-]

Your baby will stay with you unless he or she needs extra care.

Breastfeeding is best for babies, and there’s no reason why you shouldn’t breastfeed your baby. Whichever way you choose to feed your baby, you should start feeding him or her as soon as possible after birth, and then every two to three hours to help your baby’s blood glucose stay at a safe level.

Your baby should have a blood glucose level tested a few hours after birth to make sure that it is not too low. Your baby may need to be looked after in a neonatal unit if he or she is unwell, needs close monitoring or treatment, needs help with feeding or was born prematurely. Gestational diabetes usually gets better after birth and therefore you are likely to be advised to stop taking all diabetes medications immediately after your baby is born. Before you go home, your blood glucose level will be tested to make sure that it has returned to normal.

What follow-up should I have?

You should have a test for diabetes at your postnatal check, which may be with your GP. If your blood glucose levels are still high you will be referred to a doctor specialising in diabetes. Women who have had gestational diabetes have a one in three chance of developing Type 2 Diabetes within the following five years.

You should be given information about your lifestyle, including diet, exercise and watching your weight, to reduce your chance of diabetes in the future.You will also be advised to have a fasting blood glucose test once a year.